That is certainly a concern, but the 'capture by psychiatry' isn't a single sided process, many disciplines are happy to 'off load' their more problematic patient groups to psychiatry. Gastroenterology started hiving off IBS to CBT practitioners 20 years ago (sort of swap for stomach ulcer sufferers) and any patient who is unco-operative enough not to respond to Rheumatology, Neurology and even Orthopaedics treatments risks getting a one way somatisation ticket to psychiatry. Capture by psychiatry is only possible because of ejection, rejection or indifference by other disciplines, and that ejection, rejection or indifference also impacts negatively upon research efforts. If change is wanted (I assume we are all agreed that is the case) then there is no choice but to pursue a campaign for increased research funding, and the question becomes whether classification is a fundamental element to that campaign, or whether it's a side issue which detracts from the primary focus; my argument is that it's a distraction, or indeed is even worse because it places the campaign(s) for research funding in an unnecessarily oppositional context.

IVI

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More funding for cohorts from the local phone book? I disagree more ridiculous research isn't needed. At this point, what matters is forcing the CDC et al in tightening up the definition to clearly articulate who has what. The wastebasket must be emptied.

That is a very idealised view of psychiatry and while there has been progress in the last 30 years in terms of empowering and enabling psychiatric patients to have input and even control over their treatment, at heart psychiatry is, in most developed countries still, the bureacratisation of medicalised control. What other professionals are empowered by the State to enforce indeterminate imprisonment upon citizens ? even a Judge has to be presented with prima facie evidence of wrong doing before committing someone to time limited remand. Yet in many Countries two psychiatrists merely have to agree there are grounds for detention. The decisions to detain may in most cases be wholly in the best interests of the patient but nevertheless such power to detain has wide implications for the premise on which Psychiatry is founded.

Indeed Psychiatry operates under an expectation of compliance in a way that is only very limited in other medical disciplines and in the UK the Law has actually become far more draconian in the last decade meaning that individuals with serious mental health impairments are criminalised for not being compliant with the medication regimes demanded by psychiatrists

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@Dolphin: As you probably know, but some others may not know, Thomas Szasz has made interesting observations like this on psychiatry.

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Thanks to IVI and Dolphin for this. As I had the misfortune to live in Oxford when I got ill I was in the hands of psychiatrists from the off and was initially dumbstruck by the more-or-less naked contempt for patients. Then I learnt that due to budget constraints (mental health being grossly underfunded) the majority of their work was dealing with 'statutory obligations', much of which invovles sectioning people ie locking them up agains their will. This may or may not be appropriate but it certainly seems to colour their approach to the doctor-patient relationship.

Thanks to IVI and Dolphin for this. As I had the misfortune to live in Oxford when I got ill I was in the hands of psychiatrists from the off and was initially dumbstruck by the more-or-less naked contempt for patients. Then I learnt that due to budget constraints (mental health being grossly underfunded) the majority of their work was dealing with 'statutory obligations', much of which invovles sectioning people ie locking them up agains their will. This may or may not be appropriate but it certainly seems to colour their approach to the doctor-patient relationship.

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Thanks for that. You might be interested to know that the UK spends one of the highest amounts on mental health of any country (or maybe it was any European or EU or OECD country - can't remember the specific details I read). IIRC, it's something like 13%. Can't remember the average - think it might be 7-8% (but less sure on that than the 13% figure).

That is a very idealised view of psychiatry and while there has been progress in the last 30 years in terms of empowering and enabling psychiatric patients to have input and even control over their treatment, at heart psychiatry is, in most developed countries still, the bureacratisation of medicalised control. ...

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probably so; I was going partly by what I was told by a master student; probably not representative of the field as a whole.

still, they do give medicine for most psychiatric-classified diseases. they do not treat most of these primarily with CBT.

Thanks for that. You might be interested to know that the UK spends one of the highest amounts on mental health of any country (or maybe it was any European or EU or OECD country - can't remember the specific details I read). IIRC, it's something like 13%. Can't remember the average - think it might be 7-8% (but less sure on that than the 13% figure).

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The mental health charities here, and quite a lot of commentators too, comment how underfunded mental health services are in the UK, so things must be grim in Europe. But given the lack of funds, why are psychiatrists so keen to make a play for CFS patients who do not exactly attract NHS cash?

Thanks for that. You might be interested to know that the UK spends one of the highest amounts on mental health of any country (or maybe it was any European or EU or OECD country - can't remember the specific details I read). IIRC, it's something like 13%. Can't remember the average - think it might be 7-8% (but less sure on that than the 13% figure).

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2007/08 UK health spend was 102bn, while the Mental Health spend was 5.2bn - so the proportion was roughly 5%. European comparisons are difficult but one has to remember that overall UK Health spending has been significantly lower as a proportion of National Income than in the rest of Europe - that situation improved 1997 - 2010 but Mental Health spending did not increase at the same rate as overall health spending in that period.

On the face of it, it is very ironic that psychiatry has been so desperate to add the CFS 'package' to its already overstretched portfolio, however what appears to have underlain that enthusiasm is the concept that CFS was low hanging fruit in the sense that White et al believed that with relatively cheap inputs (CBT/GET) CFS sufferers could be discharged from both hospital lists and Incapacity Benefit lists, yielding a high bang for bucks in response to the Government's demand for increased effective treatment outturns by the NHS, and rapid reductions in the IB count.

Canada lags behind most developed countries in the amount it spends to treat mental illness, with Ontario and Saskatchewan spending the least, according to a major study of mental health spending in this country.

By The Ottawa Citizen May 22, 2008

Canada lags behind most developed countries in the amount it spends to treat mental illness, with Ontario and Saskatchewan spending the least, according to a major study of mental health spending in this country.

The study represents the first time Canadian researchers have tried to measure mental health spending by province.

In 2003-04, Canada spent $6.6 billion on mental health, representing just 4.8 per cent (or $197 per person) of the total health budget, says the study, published this month in the Canadian Journal of Psychiatry. The amount is less than the five per cent that European health economists consider the minimum acceptable amount to treat mental illness.

That puts Canada, along with Italy, at the bottom of the list in mental health spending by developed countries. As a share of the total health budget, Britain spent the most (12.1 per cent), followed by Germany (10), the Netherlands (8), Denmark (8), the U.S. (7.5), Ireland (6.8) and Australia (6.7).

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Mental Health services may be overburdened in the UK. But that doesn't mean they're more overburdened than in other countries. Here inpatient spaces seems even tighter - which helps to ensure that we don't tend to get children locked up with M.E. or MSbP. It's one reason why I think people with ME/CFS should be cautious about calling for a lot more money going to mental health in general.

Mental Health services may be overburdened in the UK. But that doesn't mean they're more overburdened than in other countries. Here inpatient spaces seems even tighter - which helps to ensure that we don't tend to get children locked up with M.E. or MSbP. It's one reason why I think people with ME/CFS should be cautious about calling for a lot more money going to mental health in general.

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I think you overrate our influence on the British government But mental health certainly has funding problems (IVI's figures looked solid to me) - why would we want to suggest otherwise when people with mental health problems struggle to get the help they need? We've a lot in common with other patient groups who are also getting a raw deal, and I would speak up for their right to get more help - without compromising my own view that mental health is the wrong place to be basing CFS services.

Haven't heard anyone do that, but mental health certainly has funding problems (IVI's figures looked solid to me) - why would we want to suggest otherwise when people with mental health problems struggle to get the help they need? I would certainly speak up for their right to get more help - without compromising my own view that mental health is the wrong place to be basing CFS services.

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As was said suggested, well funded mental health services and psychiatrists can have more time and resources to cause mischief. I think UK psychiatrists have caused more mischief on average than some other countries for people with ME/CFS both for individuals and in medical journals.

IVI's figures are not comparative figures between countries - the figures I highlighted were comparative figures published in a medical journal which showed the UK was spending a higher percentage on mental health than other countries. I'm not sure how the calculations were done and what spending was involved.

Anyway, it's not a big point for me. But when it was suggested that spending was low in the UK, I thought I'd point that the evidence I've seen is that it is not low by international standards.

As was said suggested, well funded mental health services and psychiatrists can have more time and resources to cause mischief. I think UK psychiatrists have caused more mischief on average than some other countries for people with ME/CFS both for individuals and in medical journals.

IVI's figures are not comparative figures between countries - the figures I highlighted were comparative figures published in a medical journal which showed the UK was spending a higher percentage on mental health than other countries. I'm not sure how the calculations were done and what spending was involved.

Anyway, it's not a big point. But until I see better evidence, I remain to be convinced the spending in the UK is low by international standards.

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Just edited my earlier post as you wrote that. But as IVIs figures show the UK spend is small and not keeping up, which is the point about underfunding of mental health services - we have a lot in common with other patient groups getting a raw deal, and I personally wouldn't want to do them down.

Just edited my earlier post as you wrote that. But as IVIs figures show the UK spend is small and not keeping up, which is the point about underfunding of mental health services - we have a lot in common with other patient groups getting a raw deal, and I personally wouldn't want to do them down.

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Well, we don't know what is the right amount to spend. Just because some people may not get good services doesn't mean the total spend as a proportion is too low. A lot more people may end up in psychiatric services in the UK because they may do less testing; or because of medical culture or whatever.

But what Sharpe and others are arguing is that with the development of neuropsychiatry as a discipline largely replacing the classic conceptual divisions of 'brain illness' and 'mental illness', then the formerly used classification differentials may no longer apply.

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But right now, it is just ideology. And it will remain ideology until the two disciplines are firmly intertwined based on neurological correlates. In the mean time, isn't it strange that Sharpe is more interested in demonizing the patient advocates, rather than the neurologists who seem to be committing the same fallacy based on those survey results.

Another source for figures on spending on mental health in the UK (this one doesn't have comparative data with other countries):

9% of the National Health Service's and social services' spending in Northern Ireland, 11% in Scotland, 12% in England and an estimated 12% in Wales is allocated to mental health services. This is disproportionate to the human and economic costs of mental disorders.

Given that the population covering England and Wales would be approximately 90% of the sample, and N. Ireland is only around 1/40 of the total, a weighted average on those figures would be close to 12% (the real figure could be just above or just below 12% because of rounding).

Another source for figures on spending on mental health in the UK (this one doesn't have comparative data with other countries):http://www.rcpsych.ac.uk/campaigns/fairdeal/whatisfairdeal/funding.aspx (source: Royal Colleges of Psychiatrists website, where they're looking for more spending in the area i.e. there's no value to them in inflating the figure)

Given that the population covering England and Wales would be approximately 90% of the sample, and N. Ireland is only around 1/40 of the total, a weighted average on those figures would be close to 12% (the real figure could be just above or just below 12% because of rounding).

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Well, that looks pretty comprehensive and reliable data to me and I'm happy to assume it's correct. I also contacted MIND, the UK mental health charity: they don't seem to specifically criticise overall mental health funding but they do want more money for talking therapies and from my personal knowledge, access to talking therapies is poor for those who want it in at least some areas. Seems odd they should be so keen to push this underfunded service to those who don't want it.

Well, that looks pretty comprehensive and reliable data to me and I'm happy to assume it's correct. I also contacted MIND, the UK mental health charity: they don't seem to specifically criticise overall mental health funding but they do want more money for talking therapies and from my personal knowledge, access to talking therapies is poor for those who want it in at least some areas. Seems odd they should be so keen to push this underfunded service to those who don't want it.

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Those RCPsych figures are NHS and Social Services spends combined and expressed as percentages of both Health and SS budgets and therefore include community care where support and housing budgets may distinguish poorly between psychiatric and elder(dementia) care or multiple needs care where a psychiatric component of overall disability tends to be the lead specialism. The combined Health and SS budgets in 2004/5 were approximately 118bn - split 100/18; as community care represents a very significant percentage of the SS budget, the combined MH and SS spend as expressed as a percentage of the combined Health and SS budgets is disproportionate when compared to the percentage of the Health spend committed to MH. The 5% of NHS spend on Mental Health is correct. The SS budget for specified MH spending is just 1bn but this excludes the percentage of MH spending contained within the 8bn plus elder care budget.

Simple cost comparisons mean very little without reference to demand and impact figures. Mental Health provision (or the lack therefof) has one of the highest impacts upon well/ill being of society, and is matched perhaps only by nutrition in the scale of its effects - no other area of health is concerned with criminality, education, child and young person well being, addiction, and suicide - all areas identified by Governments of the last fifty years as being of especial concern. We don't like having crazy people on our streets because they are not nice to look at, we no longer find it acceptable to lock mentally ill people up in institutions that are prisons in all but name, addictions destroy not just the addicts but the people around them, as does suicide and most of us find even just the notion of a psychologically distressed child to be abohrent. One in four people in Britain will at some point in their lives be desperate enough to seek medical intervention for a psychological condition, to meet the European average direct (non domicilary/SS) mental health spend the UK will need to increase its NHS commitmant to Mental Health services by at least another 2bn per annum - or 40% rise on 2007/8. And that's without the inexorable rise in dementia.

Is that a story about psychiatrists ? Bad parents, bad judicial system, bad school system, bad psychiatrists, bad other doctors - life is monstrously imperfect. What in 1990 with the state of knowledge in backwater USA about CFS, should the psychistrists have done ? And what do these oft repeated 'horror' stories tell us about anything in general - does Harold Shipman tell us something fundamental about General Practice in the UK ? Of course not. Psychiatry is very imperfect and the world would be a better place if Psychiatrists could more frequently acknowledge their limitations, but society gets, as with its politicians, the psychiatrists, surgeons and GPs it deserves

Maverick Prowles
Had Rumbling Bowels
That thundered in the night.
It shook the bedrooms all around
And gave the folks a fright.

The doctor called;
He was appalled
When through his stethoscope
He heard the sound of a baying hound,
And the acrid smell of smoke.

Was there a cure?
The higher the fewer
The learned doctor said,
Then turned poor Maverick inside out
And stood him on his head.

Just as I thought
Youve been and caught
An Asiatic flu -
You musnt go near dogs I fear
Unless they come near you.

Poor Maverick cried.
He went cross-eyed,
His legs went green and blue.
The doctor hit him with a club
And charged him one and two.

And so my friend
This is the end,
A warning to the few:
Stay clear of doctors to the end
Or theyll get rid of you.

does Harold Shipman tell us something fundamental about General Practice in the UK ? Of course not.

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Yes it does.

It tells us that GPs were/are operating in a system with too little over-sight, too much trust, and that it was/is too easy for them to get away with abusing their patients.

Individual cases are often important in helping us understand how the systems we rely upon operate in unusual and challenging circumstances. It doesn't show how many GPs are intentionally killing their patients - but Shipman himself was only one of the problems which his case revealed to us. If society gets the psychiatrists, surgeons and GPs it deserves, then they're failings should be taken as indications as to how we should try to progress as a society.

Is that a story about psychiatrists ? Bad parents, bad judicial system, bad school system, bad psychiatrists, bad other doctors - life is monstrously imperfect. What in 1990 with the state of knowledge in backwater USA about CFS, should the psychistrists have done ? And what do these oft repeated 'horror' stories tell us about anything in general

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(Don't have time to read the David Bell piece but) With regard to children, I imagine that child protection "horror" cases are expensive - there are a lot of manhours involved, with case conferences, etc; and then any subsequent inpatient treatments are very expensive.

I think it could be well worthwhile to do certain medical tests - with abnormalities (even if they wouldn't give a ME/CFS diagnosis definitively) suggesting it's not Munchausen's Syndrome by Proxy and the like.

Also, the traumatic effect which might be hard to calculate economically. We make a lot of effort, and spend a lot of money on legal systems, not to send people to prison unless there is good evidence and not to have miscarriages of justice.